Organisational culture: variation across hospitals and connection to patient safety climate.

CONTEXT: Bureaucratic organisational culture is less favourable to quality improvement, whereas organisations with group (teamwork) culture are better aligned for quality improvement. OBJECTIVE: To determine if an organisational group culture shows better alignment with patient safety climate. DESIGN: Cross-sectional administration of questionnaires. Setting 40 Hospital Corporation of America hospitals. PARTICIPANTS: 1406 nurses, ancillary staff, allied staff and physicians. MAIN OUTCOME MEASURES: Competing Values Measure of Organisational Culture, Safety Attitudes Questionnaire (SAQ), Safety Climate Survey (SCSc) and Information and Analysis (IA). RESULTS: The Cronbach alpha was 0.81 for the group culture scale and 0.72 for the hierarchical culture scale. Group culture was positively correlated with SAQ and its subscales (from correlation coefficient r = 0.44 to 0.55, except situational recognition), ScSc (r = 0.47) and IA (r = 0.33). Hierarchical culture was negatively correlated with the SAQ scales, SCSc and IA. Among the 40 hospitals, 37.5% had a hierarchical dominant culture, 37.5% a dominant group culture and 25% a balanced culture. Group culture hospitals had significantly higher safety climate scores than hierarchical culture hospitals. The magnitude of these relationships was not affected after adjusting for provider job type and hospital characteristics. CONCLUSIONS: Hospitals vary in organisational culture, and the type of culture relates to the safety climate within the hospital. In combination with prior studies, these results suggest that a healthcare organisation's culture is a critical factor in the development of its patient safety climate and in the successful implementation of quality improvement initiatives.

Crown lengthening: a clinical review.

The use of crown lengthening surgery as an adjunct to restorative therapy was first suggested by Rosen and Gitnick. This technique is designed to increase the clinical crown heights of teeth requiring restoration following extensive wear through attrition, abrasion and erosion. This loss of tooth tissue and resulting clinical crown height may be localized to a few teeth or affect the entire dentition. This clinical problem is reflected by the increasing number of reports of treatment of the worn dentition.

Review of the Swinglock removable partial denture.

The author's experience with the swinglock removable partial denture concept is described. This infrequently utilized technique allows the use of undercuts that are unapproachable with other partial denture designs. Indications include missing or weakened key abutment teeth, tooth mobility, aesthetics, economic considerations, and the presence of certain ablative defects following oncologic surgery. The clinician must consider lip position, facial sulcus depth, position of frena, and the periodontal health of potential abutment teeth when considering a swinglock removable partial denture. Specific instructions for blockout, relief, and position of hinge and clasp assemblies should be part of the written laboratory instructions.